SAN FRANCISCOThe results of three studies presented at the 2006 Prostate Cancer Symposium suggest that "watchful waiting," monitoring men who have prostate cancer instead of actively treating the disease, may not be the best option for some men with low-risk disease, including older men.
Using data from the Surveillance, Epidemiology and End Results (SEER) Medicare database, Yu-Ning Wong, MD, an attending physician at Fox Chase Cancer Center, and her colleagues analyzed overall survival data for 48,606 men between the ages of 65 and 80 who were diagnosed with localized prostate cancer between 1991 and 2003 (abstract 271). Only men with well or moderately differentiated tumors, stage T1-T2a or T2b-T2c, who lived for at least 365 days after the diagnosis were included in the analysis. The researchers only investigated overall mortality, not prostate-cancer- related mortality.
Men were included in the treatment group if claims were made for radical prostatectomy, hormone therapy, or radiation therapy within 6 months of diagnosis. Otherwise, men were placed in the watchful waiting group.
The median overall survival for men in the treatment group was greater than 156 months (13 years) vs 121 months (10 years) for the observation group. The men in the treatment group were more likely to be Caucasian, to be married, to belong to a higher socioeconomic group, and to have fewer comorbidities, compared with the watchful waiting group. However, Dr. Wong noted that "even when you adjust for all the differences between the groups, there still is a survival advantage to being treated."
He concluded that "this large study suggests a survival benefit to treatment in men with low- and intermediate-risk prostate cancer in the Medicare population. Elderly men should be considered for treatment with radiation or surgery."
The results of a study (abstract 37), presented by D. Andrew Loblaw, MD, MSc, assistant professor of radiation oncology, University of Toronto Sunnybrook Regional Cancer Centre, suggest that "active surveillance" with "selective delayed intervention" may be a more suitable option than watchful waiting for some men with low-risk prostate cancer.
Active surveillance involves periodic PSA testing and prostate biopsies, with treatment initiated if more aggressive disease is detected.